Pediatrician says my daughter "looks malnourished"

[uccellina]

My twins were born at 36 weeks and had two weeks in NICU. My son never quite got his latch right and has been supplemented since birth. My daughter was supplemented for a while, but has been exclusively breastfed for about two months now. They will be 4 months old this week, and today at the pediatrician's my son weighed 12lbs 5oz (up 1lb 1oz from last month) and my daughter weighed 9lbs 1oz (up 4oz from last month). They are both hitting their milestones. In fact, my daughter is rolling over already, which her brother hasn't yet mastered.

The pediatrician expressed serious concern over my little girl's weight gain, or lack thereof. He said she "looks malnourished," and that there was clearly "something funny going on." He thinks I'm not making enough milk for her. His proposed solution is to supplement her with one bottle a day and breastfeed her brother one time less each day. He made breastfeeding sound like some kind of selfish hangup of mine ("I know it's important to you, but . . .")

Feeding my boy less breastmilk doesn't feel right to me at all, and I won't do it. I don't mind my daughter getting one bottle a day, I guess. I'm going back to work tomorrow anyway and will be pumping to maintain my supply. I'm already taking Lactate Support pills, eating oatmeal, and drinking dark beer each day. I just feel awful and need some reassurance that I'm not crazy or somehow hurting my children by insisting on breastfeeding.

Also, if anyone has more ideas on how to up my supply . . . I'm already looking into Domperidone.

[JustJamie]

I think I'd get a second opinion before I did anything differently.

[uccellina]

We are going to get a second opinion, definitely.

[MaryJaneLouise]

Where are your twinks on the growth charts? Remember to use the BF charts, not the formula fed ones:

http://www.kellymom.com/babyconcerns/growth/index.html

Here is some info on increasing weight gain if your LOs are sinking on their weight gain curves.

Also see the "low milk supply" stickie at the top of this forum.

Good luck!

[bri276]

so your son already gets some formula? do you think there's a chance she has a weak suck? do you feed them both from each breast? also make sure they are ALWAYS weighed on the same exact scale.

how many wet and poopy diapers is your daughter having? how often does she nurse? I certainly would not take the advice to nurse your son less, but I might try having her be the first one to eat if a stretch goes by where neither have eaten in a couple hours. I don't think one bottle a day is out of line for a baby who is gaining very slowly at this point. Is that a current picture in your siggy? I can understand the ped's concern, even if I disagree with some of what he said. Even according to the breastfed growth charts, she is off the chart. but there is still plenty of time for your milk supply to increase and pumping will help too.

[uccellina]

Originally Posted by bri276

so your son already gets some formula? do you think there's a chance she has a weak suck? do you feed them both from each breast? also make sure they are ALWAYS weighed on the same exact scale.

how many wet and poopy diapers is your daughter having? how often does she nurse? I certainly would not take the advice to nurse your son less, but I might try having her be the first one to eat if a stretch goes by where neither have eaten in a couple hours. I don't think one bottle a day is out of line for a baby who is gaining very slowly at this point. Is that a current picture in your siggy? I can understand the ped's concern, even if I disagree with some of what he said. Even according to the breastfed growth charts, she is off the chart. but there is still plenty of time for your milk supply to increase and pumping will help too.

Yes, my son gets some formula. I don't think she has a weak suck, no. Usually, when we tandem nurse, she gets the higher-supply side first and often just stays there. When I'm nursing only her she gets both sides. The babies were both weighed on the same scale.

She's a regular wetter but an infrequent pooper - her record to date is seventeen days, but the last two weeks it has been once every seven days (an improvement).

Unless I'm misreading the charts linked above (totally possible) it looks like she is just slightly below the bottom curve for a full-term baby, and somewhat above it for a three-month old?

The photo is a month old. She does have big eyes, but that picture really emphasizes them. Here's another photo from June 8.

[eclipse]

Is your ped looking at the charts for her adjusted age? Because I'm with you, she's on the chart for a 3 month old. How much did she weigh at birth?

[uccellina]

She was 4lbs, 12oz at birth.

[RootSnort]

I would see a lactation consultant (IBCLC) and get a second pediatrician's name from her!

[MaryJaneLouise]

I don't think LESS breastmilk makes any sense, either. If you have to supplement, try to do it with human milk (your pumped milk or donor milk). And, try to supplement at the breast, or with something that will not cause nipple preference for a faster flowing bottle.

The fact that she gained only 4 oz in 4 weeks is a little concerning at this age, however. She should be gaining about 5 oz each week.

I think it would be worth your while to try to increase your milk production, either with the good herbal stuff (More Milk Plus from motherlove.com, or Shatavari from Ayurceutics http://www.lowmilksupply.org/shatavari.shtml#obtain or domperidone from one of the sources in the low milk supply stickie.

PS And no, you're not crazy or selfish for wanting to BF. Just exactly the opposite. It is hard to carry on BFing, especially twins, in this : world of ours :

[eclipse]

Originally Posted by uccellina

She was 4lbs, 12oz at birth.

So, she's about doubled her birth weight by 4 months? Sounds fine to me. I'd be concerned if she wasn't meeting milestones (for her adjusted age, and it sounds like she's ahead of the curve), not wetting a lot (at her age, pooping isn't really a concern), unhappy frequently or sleeping all the time, stops gaining altogether or looses weight, etc. I would keep an eye on it, but I wouldn't be pushing formula.

[pdxmomazon]

just wanted to reaffirm that you are NOT selfish for wanting to breastfeed. I've heard that, too and it makes me want to scream! You are awesome for working so hard to give your twins the best food in the world. Way to go!

[bri276]

So, she's about doubled her birth weight by 4 months? Sounds fine to me.

but she was supplemented for the first 2 months and this last month has gained as much as would be normal for one week.

I am not an advocate of formula supplementation when it's not necessary. AT ALL. I exclusively pumped for 21 months and my baby was very slow to gain in the beginning. But a 4 oz gain in 1 month is not normal. Obviously she is your child and you have to do what you are comfortable with. As much as we all want every baby to be exclusively bf'ed, it isn't always 100% possible. I just think that sometimes, supplements are actually warranted and in this case I personally would- it doesn't mean to stop bf'ing by any means- it is more than possible to do both. If you can pump (or even get some donated milk) and use a method other than bottlefeeding, that would be ideal.

as far as where she is on the chart- my DD was on the bottom rungs for many, many months- someone has to be there, right? I don't know if the WHO growth charts including infants born at 36 wks gestation as full term or whether adjusting would be appropriate; however, lack of significant weight gain is much more important than exactly where on the chart she plots. It is very reassuring that she's developing and happy

at her age, pooping isn't really a concern

eta, I just wanted to address the reason why I asked about pooping. while infrequent poops do not always indicate lack of breastmilk by any means (sometimes they're getting exactly what they need and have little waste) regular, normal poops do indicate a good supply, and frequent mucousy and/or bloody poops may indicate an allergy which can contribute to poor weight gain. Just wanted to clarify why I asked.

[Jaysfamily]

Run away now, lol! My son was a 35-weeker and our old pediatrician's office was beyond obsessed with his weight. My son would sometimes only gain a half a pound a month, but he would poop 1-5 times a day so I know he was getting enough, plus I supplemented him with Alimentum.

What would worry me about your daughter is the lack of stool combined with the low weight gain, but I'm no expert by any means. What would worry me about the pediatrician is that he said "I know it's important to you..." and that he told you to bf LESS. That sends up warning flags to me that he's only going along with the whole breastfeeding thing because you're pushing it, and not because he believes that breastmilk is truly the healthiest thing for babies to eat. It's one thing to have to supplement due to low supply, but advice to bf less just makes no sense.

[p1gg1e]

She more then doubled!! WTG!! I think the only thing you could do is keep her in a sling and offer more but man she looks great to me

wanted to add "36" may not be true. You may have "needed" to carry then if singletons to 42 weeks. so they may be 6 weeks early even.

[MissRubyandKen]

Do you feel she is getting enough hindmilk? What do her stools look like when she does go?

[thepeach80]

Your dd has a good weight for her birthweight, but her gain this past month is alarming. My dd was 9#13oz at 4 mos and absolutely starving. She is what is referred to as a 'happy to starve' baby. She never cried for more food, she was happy, but she slept a lot and it wasn't until we started supplementing that I realized she didn't have good, wet diapers. We supplemented and after a week she had gained a # and was getting closer to the weight charts. She was 7#2oz at birth. She also had a weak suck that didn't help her or my supply issues. I've had supply issues w/ all my kids, but I thought I was getting it right this time until our ped looked at her at 4 mos and suggested supplementing (she wasn't the first to be alarmed at her size, even my hardcore bfing friends thought there might be a problem). Supplementing is not the end of the world and it doesn't make you bad or what not, you obviously are o.k. w/ it as your son is supplemented as well. There are plenty of things you can try to help your supply. Try nursing and then pumping after every feed. You can use what you get from pumping to supplement some instead of using formula. We also did switch nursing where I had her switch sides for as long as I could keep her nursing to get as much milk in her as possible.

[uccellina]

Originally Posted by MissRubyandKen

Do you feel she is getting enough hindmilk? What do her stools look like when she does go?

I was wondering about the hindmilk, actually. When I pump and my milk separates in the bottle, there is a lot of watery-looking stuff and a pretty thin layer of creamy milk on top. Her stools are runny and yellow-brown.

I ordered domperidone today. Stupid me, I didn't realize you could get it without a prescription.

Today was her first day being supplemented, and my husband says she only took 1.5oz the first go-round and 3oz later. I wonder if maybe that's all she's been getting from me, and so that's all she'll take now? Why, oh why can't she just learn to speak already and tell me what the heck's going on?

[eclipse]

3 oz is pretty normal for her age - even 1.5 oz at a feeding isn't outside the range of normal. For comparison, my ds1 and dd (who were huge) never took more than 4 oz in a feeding (except for a brief period with ds when he slept through the night and I was leaving for work so early that he didn't get a morning feed from the tap - then he'd take about 6 oz). I pumped for 18 months for ds and 12 months for dd - and again, 4 oz was pretty normal towards the end, but for the first 9 months or so, it was not unusual for me to come home to most of the 4 oz bottles I made with an oz or two left in them.

I think taking Dom might be a good idea, especially since you're going back to work and have to pump for two.

[uccellina]

I'm so glad that's normal! I was surprised because my son eats 5-6oz at a time, fat little boy that he is